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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Krugman: Why Dems Can Be Proud of the Affordable Care Act

New York Times columnist Paul Krugman answers an important question on the minds of many voters, “are Democrats really credible on health care?”

Almost five years after Obamacare went into full effect, the answer is a very clear yes. It hasn’t worked perfectly, and its successes haven’t come in quite the form its proponents expected. But it has delivered huge progress, especially in states run by politicians who are trying to make it work.

It’s worth remembering what Republicans said would happen before the A.C.A. went online: that it would fail to reduce the number of uninsured, that it would blow a giant hole in the budget, that it would lead to a “death spiral” of rising premiums and declining enrollment.

What actually happened was a dramatic fall in the uninsured, especially in those states that expanded Medicaid. The budget costs of expanding Medicaid and subsidizing other insurance have been significant, but estimates for 2019 suggest that these costs will be around $115 billion — much less than half the revenue lost due to the Trump tax cut.

Krugman concedes that premiums “rose sharply when the people signing up for those exchanges turned out to be fewer and sicker than insurers had hoped.” However, “the markets have now stabilized, with only modest premium increases for 2019 and insurers returning to the exchanges.”

In addition, “Medicaid is covering more than expected, so that overall gains in coverage have been surprisingly on target. In early 2014, the Congressional Budget Office projected that under the A.C.A., by 2018 there would be 29 million uninsured U.S. residents. The actual number is … 29 million.”

And, despite the assault on the Affordable Care Act by Trump and the Republicans, “Democrats built their system so well that it’s still standing despite everything thrown at it.” Further,

…Obamacare would be doing even better if it were run by people who weren’t trying to kill it. Look at what’s happening in New Jersey, where a Democratic governor and Legislature have used their powers to undo most of the Trumpian sabotage: 2019 premiums will actually drop 9.3 percent, even as they rise modestly in the nation as a whole.

…Republicans, on the other hand, aren’t just lying about their health plans — pretending, for example, to protect people with pre-existing conditions when they aren’t. They’ve also been utterly wrong about everything, and have learned nothing from their mistakes.

Even the conservative Democrat Joe Manchin is running strong in a state Trump won by 42 percent by attacking the Republican plan to eradicate protection for people with pre-existing conditions. As Krugman concludes, “Democrats have earned a lot of credibility on health care: They delivered what they promised, and they have showed that they can build systems that work” — in stark contrast to their GOP opponents, who can’t pass any health care measures, despite having control of the presidency and majorities of both houses of congress.

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